Background and Aims:The Neutrophil-to-Lymphocyte Ratio (NLR) is suggested as a readily available and inexpensive biomarker to predict prognosis of acute stroke.Experience with intravenous (IV) tissue plasminogen activator (tPA) treatment is limited. Methods:142 (80 female, age: 69±13yr) consecutive acute stroke patients treated with IV rtPA were enrolled. Admission and 24h lymphocyte, neutrophil and monocyte counts were measured and the NLR was calculated. Results: Average NLR elevated (by 3.47±6.75) significantly from admission to 24th hour (p<0.001). 52% of patients exerted good response to IV rtPA, while 27% showed dramatic response. The patients with “thrombolysis resistance” had significantly higher 24h NLR (p= 0.001). In the end of 3rd month, 46.5% of patients had favorable (mRS 0-2) and 32.4% had excellent (mRS 0-1) outcome. Patients without favorable/excellent outcome had significantly elevated 24h NLRs.Linear regression analysis indicated that post-tPA NLR, but not admission, was independent negative predictor of excellent (=-0.216, p=0.006) and favorable (=-0.179, p=0.034) outcome after adjustment for age, hypertension and NIHSS. Nine patients developed PH2 had very significantly elevated pre-tPA (7.6±7.39 vs 3.33±3.07, p<0.001) and 24h NLR (26.2±18.6 vs 5.78±4.47, p<0.001). Of note, AUC of ROC curve of NLR failed to detect any reliable threshold for absence of tPA effectiveness/dramatic response, 3rd month good/excellent outcome or any type tPA-induced hemorrhage. Conclusions: As a marker of stroke-associated acute stress response, the NLR, which increases during the first 24 hours, is an epiphenomen of poor prognosis. However, pretreatment NLR values have no importance in predicting IV tPA response.
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